Freeman Health System Uses VigiLanz to Enhance MRSA Screening, Reduce Vancomycin Use

Customer Profile

Freeman Health System, a 485-bed, three-hospital system in Joplin, Missouri, serves an area of 450,000 people across Missouri, Arkansas, Kansas, and Oklahoma. It is the #1 hospital in Southwest Missouri and the #4 hospital in Missouri, according to U.S. News & World Report.

Challenge

Hospitals across the country are fighting to combat antibiotic overuse, resistance, and unwanted side effects, but many are struggling to implement new and effective workflows that help meet these goals. Much of the challenge boils down to speed and efficiency—hospitals need to identify antibiotic overuse more quickly, and intervene sooner when it does occur.

Freeman Health System is no exception to the challenges associated with antimicrobial stewardship (ASP), and it was looking for a way to improve its ASP processes, particularly related to vancomycin use among patients with pneumonia.

“Data shows that 98 percent of the time, a negative MRSA screen for a patient with pneumonia means that a patient does not have MRSA-pneumonia, and their empiric vancomycin therapy can safely be discontinued,” said Adrienne Carey, PharmD, BCPS, Clinical Pharmacist and Data Mining Program Manager at Freeman Health System. “We wanted to streamline our MRSA screening process so that we could more quickly identify if a MRSA screen is negative, and therefore, discontinue vancomycin use sooner.”

Solution

Freeman Health System’s antibiotic stewardship team had already changed the health system’s pneumonia pathway orders to ensure all patients who came into the ER automatically received a nasal screen for MRSA.

“Our pharmacy department was tasked with educating physicians about the change and with contacting them with the results,” said Carey. “The goal was to de-escalate patients’ antibiotics more quickly.”

The problem was that results were not always communicated quickly to pharmacists, so there was sometimes a delay in identifying patients whose vancomycin therapy could be discontinued.

Freeman Health System turned to VigiLanz to help, working with the VigiLanz clinical support team to create a negative MRSA screen rule within the system. Now, whenever a patient prescribed vancomycin has a negative MRSA screen and no other cultures are positive for MRSA, the pharmacy team and infectious disease physician receive an alert in real time.

“Before implementing the VigiLanz rule, we had to manually run reports through our health information system to view all patients on vancomycin, then check each patient’s microbiology results to see if they had been screened for MRSA,” said Carey. “That took a lot of time.”

Now, pharmacists and physicians can more quickly discontinue vancomycin use and switch to an alternate antibiotic when appropriate, she explained. “We are not leaving our patients on vancomycin any longer than necessary.”


Adrienne Carey, PharmD, BCPS describes real-time alerts helping pharmacists

Outcomes 

In the first six months since November 2018, when the new workflow was implemented, Freeman Health System’s pharmacists worked with physicians to discontinue vancomycin therapy in 70 patients.

Other key benefits of the new approach include:

  • Time savings for pharmacists
  • Time savings for nurses by reducing doses and drawing fewer labs
  • Monetary savings by reducing unneeded antibiotics
  • Reduced risk of infection through an IV route since IV lines are discontinued sooner due to de-escalation
  • Fewer medication side effects
  • Less chance for antibiotic resistance
  • Improved patient satisfaction due to fewer medications being administered
  • Shorter lengths of stay

“Building this rule and receiving immediate alerts from VigiLanz is helping us better identify all patients who qualify to have their therapy de-escalated and do so in a timely fashion,” said Carey. “We have also seen a trend toward less vancomycin usage overall.”

Related Resource:

Technology Can Help with Vancomycin Dosing

Pharmacy Practice News recently interviewed Houston Methodist Hospital about how they are using VigiLanz precision dosing powered by DoseMeRx to gain instant access to personalized dosing for vancomycin and other antimicrobials. Here’s an excerpt:

Technology Can Help With Vancomycin Dosing

By AI Heller

Houston Methodist Hospital (HMH) is leading a shift this September toward AUC (area under the curve) antimicrobial dosing in all eight facilities of the Houston Methodist health system, said William L. Musick, PharmD, BCIDP, a clinical specialist in infectious diseases at HMH’s 1,200-bed flagship location.

“We knew for almost two years this would be the direction of the new vancomycin guidelines, and the direction we had to move,” Dr. Musick said.

Click here to read the full Pharmacy Practice News article.  

Hospital Patient Safety Report: Medication Errors

To better understand the state of hospital patient safety and the biggest opportunities for improvement, VigiLanz commissioned Sage Growth Partners, a healthcare consultancy, to conduct an independent survey of 100 hospital and health system leaders in February 2020.

View the full report here.

This infographic highlights some of the most noteworthy medication error-related survey findings. The infographic reveals:

  • Where they rank medication errors on a list of top safety problems
  • Whether hospital leaders say medication error rates are falling
  • How they are using technology to support their efforts

Economic Value Tool – Calculate Your Savings

Healthier Patients, Healthier Bottom Line

Calculate Your Savings
See how your hospital or health system could be using VigiLanz to save millions by optimizing efficiency and improving patient safety.

VigiLanz leads to savings throughout your health system—from the pharmacy department, to infection prevention, to overall quality and safety.

We’ve designed this calculator to provide insight into VigiLanz’s high economic impact. VigiLanz improves workflow and staffing efficiency, reduces and prevents costly safety errors and adverse events, and identifies cost-savings opportunities such as IV to PO conversions.

The tool starts with national benchmark data, but allows you to enter your own organization’s information for a more customized analysis. See your hospital’s potential savings in key areas, plus, receive a full report to see hospital-wide savings and a detailed description of the key savings drivers and methodology.

Q&A: How VigiLanz is Supporting Remdesivir COVID-19 Clinical Trials

Dr. Katherine Perez
Dr. Katherine Perez

Insights from Katherine K. Perez, PharmD, BCIDP, Co-Leader of the Houston Methodist Remdesivir Clinical Trial Program

Hospitals across the country are using VigiLanz’s rules, reports, and real-time alerts to improve care for COVID-19 patients and prevent the virus’ spread to non-COVID patients and healthcare providers. But many hospitals are also using VigiLanz’s quick customization capabilities to address their unique COVID-19 needs.

One such hospital is Houston Methodist, which has been using VigiLanz Research Services to assist with its Remdesivir clinical trial program. In this Q&A, Katherine K. Perez, PharmD, BCIDP, Infectious Diseases and Antimicrobial Stewardship Clinical Specialist at Houston Methodist, discusses the exciting initiative and shares how VigiLanz is supporting the effort.

 

Q: Can you tell us about the Remdesivir clinical trial at Houston Methodist? What are some of your most exciting findings and where are you in the process?

Perez: We finished enrolling approximately 100 patients in the Remdesivir SIMPLE trials at the end of May. Since then we have completed follow-up visits and are responding to final data queries. Our findings were certainly in line with results from the trials that resulted in Remdesivir’s emergency use authorization (EUA) in May. Since then we have based our criteria for Remdesivir EUA use on the existing data from the clinical trials. We are still using our alerting mechanism for the trial cohort that we developed with VigiLanz to organize our RDV allocation workflow [learn more about this approach in the below question and answer]. At the moment we are a site for REMDACTA, which is another clinical trial that is comparing Remdesivir with Tocilizumab versus Remdesivir alone.

 

Q: How has VigiLanz supported your efforts?

Perez: We worked with VigiLanz Research Services to build out rules based on eligibility criteria that help us identify potential clinical trial patients. When patients match that criteria, we receive notifications from VigiLanz and we can quickly review that patient’s information and determine if the patient can and should participate. This process streamlines our workflows and ensures rapid identification of clinical trial candidates. We have trained up our research nurses and coordinators to also navigate the VigiLanz alerting and have made the program a cornerstone for their department’s workflow.

 

Q: On May 1, the FDA granted EUA for Remdesivir outside of clinical trials to treat certain patients with COVID-19. What role is VigiLanz playing, given the emergency use authorization?

Perez: We created alerts in VigiLanz so that whenever a patient meets the criteria for EUA, we receive an immediate notification. We expanded the alert across the system to trigger at all eight hospitals. Also, whenever we do get an allotment of the EUA inventory, we have to prioritize the use. VigiLanz alerts help streamline that process, the same way they help us identify clinical trial patients.

 

“We worked with VigiLanz Research Services to build out rules based on eligibility criteria that help us identify potential clinical trial patients.”

 

Q: What are some other ways Houston Methodist is using VigiLanz to navigate the COVID-19 pandemic?

Perez: VigiLanz has played a key role in helping us build our treatment database. We use it to store all of our COVID-19 related data from all of our hospital partners. This data includes COVID-19-positive patients, patients who have been treated with extracorporeal membrane oxygenation (EMCO), patients who have been readmitted, and more. Having the data in one centralized location helps us analyze it and evaluate critical metrics such as average length of stay, ventilator settings, and identification of co- and secondary infections. Our approach very much mirrors the World Health Organization ordinal scale, and all of the information we need is stored in VigiLanz. This registry is going to be really powerful as we move forward.

Also, in general during the height of the pandemic, VigiLanz’s ability to streamline workflows ensured that we didn’t fall behind on our everyday tasks or needs. For example, we are very focused on antimicrobial stewardship (ASP) here at Houston Methodist, and while our pharmacists have been inundated with COVID-19 needs, VigiLanz made it easy to temporarily hand off ASP tasks to other staff members who weren’t as familiar with those responsibilities.

Are Hospitals Ready for a Second Wave of COVID?

PSQH Editor John Palmer recently interviewed Stacy Pur, Vice President of Product Development at VigiLanz, for a Q&A on clinical surveillance, patient safety, and COVID-19. Here’s an excerpt: 

With a potential second wave of COVID-19 on the horizon for the fall, combined with the regular flu season, real-time surveillance alerts may be the key to infection prevention as well as mitigating and controlling future on-premises infections.

PSQH: If clinical surveillance is so important, why do only 29% of surveyed hospitals use it? What would improve the rate of surveillance usage?

You can read Stacy’s response, and more of the Q&A, on PSQH and HealthLeaders.

  1. PSQH: https://www.psqh.com/analysis/are-hospitals-ready-for-a-second-wave-of-covid/
  2. HealthLeaders: https://www.healthleadersmedia.com/covid-19/are-hospitals-ready-second-wave-covid

Hospital Patient Safety Report: Opioid Stewardship

To better understand the state of hospital patient safety and the biggest opportunities for improvement, VigiLanz commissioned Sage Growth Partners, a healthcare consultancy, to conduct an independent survey of 100 hospital and health system leaders in February 2020.

View the full report here.

This infographic highlights some the most noteworthy opioid stewardship-related survey findings. The infographic reveals:

  • How hospital leaders rate their opioid stewardship efforts
  • Where opioid stewardship falls on their list of top safety priorities
  • How they are using technology to support their efforts

Three Things Every Hospital Should Be Doing Now to Improve Patient Safety

by David Goldsteen, MD, VigiLanz CEO

Improving patient safety has always been a priority for hospitals and health systems, but COVID-19, and the possibility of a second surge in a few weeks or months, is bringing new urgency to these efforts. All hospitals must quickly assess their current safety-related processes, identify optimization opportunities, and implement new approaches that foster a safer environment—not just for patients with COVID-19, but for all patients, staff members, and visitors.

You can read more of this article on PSQH.  

 

For more on VigiLanz’s COVID-19 rules and solutions, click here.

Second wave preparedness: Infection preventionists and pharmacy leaders discuss safety & COVID-19

The first wave of COVID-19, and the significant challenges it raised for hospitals, underscored the highly critical role that pharmacists, infection preventionists, and antimicrobial stewardship teams play in keeping patients, staff, and visitors safe.

During this panel discussion, infection prevention and pharmacy leaders from hospitals across the country shared some of the biggest challenges they encountered during the first wave of COVID-19, how they used clinical surveillance to enhance patient care, and the lessons they learned. They also shared how their organizations are preparing for a second wave of COVID-19, and the initiatives they are implementing now to ensure safer care.

During this live panel discussion, pharmacists and infection preventionists describe: 

  • The challenges they faced during the first wave of COVID-19 and how they addressed them
  • The role that clinical surveillance played in enhancing patient care
  • How they are preparing for a potential second wave of COVID-19
  • Their top recommendations for other pharmacists and infection preventionists

Hospital Patient Safety Report: Antimicrobial Stewardship

To better understand the state of hospital patient safety and the biggest opportunities for improvement, VigiLanz commissioned Sage Growth Partners, a healthcare consultancy, to conduct an independent survey of 100 hospital and health system leaders in February 2020.

View the full report here.

This infographic highlights some of the most noteworthy antimicrobial stewardship-related survey findings. The infographic reveals:

  • How hospital leaders rate their antimicrobial stewardship efforts
  • Where antimicrobial stewardship falls on their list of top safety priorities

How they are using technology to support their efforts